Welcome to the world of children's vision!

Archive for the ‘Reading problems and vision’ Category

Not very much, according to many educators. The Common Core standards, which have been adopted in most states, call for teaching legible writing, but only in kindergarten and first grade. After that, the emphasis quickly shifts to proficiency on the keyboard.

But neuroscientists say it is far too soon to declare handwriting a relic of the past. New evidence suggests that the links between handwriting and broader educational development run deep.

Children not only learn to read more quickly when they first learn to write by hand, but they also remain better able to generate ideas and retain information. In other words, it’s not just what we write that matters — but how.

“When we write, a unique neural circuit is automatically activated,” said Stanislas Dehaene, from the Collège de France in Paris. “There is a core recognition of the gesture in the written word, a sort of recognition by mental simulation in your brain.

“And it seems that this circuit is contributing in unique ways we didn’t realize,” he continued. “Learning is made easier.”

A 2012 study led by Karin James, from Indiana University, lent support to that view. Children who had not yet learned to read and write were presented with a letter or a shape on an index card and asked to reproduce it in one of three ways: trace the image on a page with a dotted outline, draw it on a blank white sheet, or type it on a computer. They were then placed in a brain scanner and shown the image again.

The researchers found that the initial duplication process mattered a great deal. When children had drawn a letter freehand, they exhibited increased activity in three areas of the brain that are activated in adults when they read and write: the left fusiform gyrus, the inferior frontal gyrus and the posterior parietal cortex.

By contrast, children who typed or traced the letter or shape showed no such effect. The activation was significantly weaker.

Dr. James attributes the differences to the messiness inherent in free-form handwriting: not only must we first plan and execute the action in a way that is not required when we have a traceable outline, but we are also likely to produce a result that is highly variable.

In another study, Dr. James is comparing children who physically form letters with those who only watch others doing it. Her observations suggest that it is only the actual effort that engages the brain’s motor pathways and delivers the learning benefits of handwriting.

The effect goes well beyond letter recognition. In a study that followed children in grades two through five, Virginia Berninger, a psychologist at the University of Washington, demonstrated that printing, cursive writing, and typing on a keyboard are all associated with distinct and separate brain patterns — and each results in a distinct end product. When the children composed text by hand, they not only consistently produced more words more quickly than they did on a keyboard, but expressed more ideas. And brain imaging in the oldest subjects suggested that the connection between writing and idea generation went even further. When these children were asked to come up with ideas for a composition, the ones with better handwriting exhibited greater neural activation in areas associated with working memory — and increased overall activation in the reading and writing networks.

Samples of handwriting by young children. Dr. James found that when children drew a letter freehand, they exhibited increased activity in three significant areas of the brain, which didn’t happen when they traced or typed the letter. Credit Karin James

It now appears that there may even be a difference between printing and cursive writing — a distinction of particular importance as the teaching of cursive disappears in curriculum after curriculum. In dysgraphia, a condition where the ability to write is impaired, usually after brain injury, the deficit can take on a curious form: In some people, cursive writing remains relatively unimpaired, while in others, printing does.

Dr. Berninger goes so far as to suggest that cursive writing may train self-control ability in a way that other modes of writing do not, and some researchers argue that it may even be a path to treating dyslexia. A 2012 review suggests that cursive may be particularly effective for individuals with developmental dysgraphia — motor-control difficulties in forming letters — and that it may aid in preventing the reversal and inversion of letters.

Two psychologists, Pam A. Mueller of Princeton and Daniel M. Oppenheimer of the University of California, Los Angeles, have reported that in both laboratory settings and real-world classrooms, students learn better when they take notes by hand than when they type on a keyboard. Contrary to earlier studies attributing the difference to the distracting effects of computers, the new research suggests that writing by hand allows the student to process a lecture’s contents and reframe it — a process of reflection and manipulation that can lead to better understanding and memory encoding.

Reflection: Instead of giving a computer for continuous use to children with academic difficulties, such as dysgraphia, the child may have to be trained to write as well as he can (while using his computer) instead of giving up! Motor training can only help the child to write better. But as today, things that do not require any effort seem to take precedence. So, it is up to you, parents, to lead this battle!

In a new Mayo Clinic study, researchers examined the physical act of reading to see if practicing eye movements in school could lead to better early reading fluency.

Reading fluency is defined as the ability to read easily, quickly, without errors and with good intonation.

Saccades or rapid eye movements are required for the physical act of reading. Previous studies have shown that the ability to perform complex tasks such as saccadic eye movements are not fully developed at the age when children begin to learn to read. Eye movements in younger children are imprecise, resulting in the need for the eyes to go back to re-read text, leading to slower performance. When translated into the task of reading, it slows the reading rate and leads to poor reading fluency and may affect reading comprehension and academic performance.

“There are studies that show that 34 percent of third graders are not proficient in reading, and if you are not proficient in reading by third or fourth grade there is a four times higher likelihood that you will drop out of high school,” says Amaal Starling, M.D., Mayo Clinic neurologist and co-author of the study published in Clinical Pediatrics.

Dr. Starling says that the purpose of the new study was to determine the effect of six weeks of in-school training using the King-Devick remediation software on reading fluency. This software allows people to practice rapid number naming which requires eye movements in a left to right orientation. It teaches the physical act of reading.

In this study, standardized instructions were used, and participants in the treatment group were asked to read randomized numbers from left to right at variable speeds without making any errors. The treatment protocol consisted of 20-minute individual training sessions administered by laypersons, three days each week for six weeks, for a total of six hours of training.

Randomized numbers are presented at variable speeds from left to right; the participants read the numbers as quickly as possible.

Examples of pages taken from the King-Devick Test

(Images deleted following a call from the company)

Students in the treatment group had significantly higher reading fluency scores after treatment and post-treatment scores were significantly higher compared with the control group. At the one-year follow-up, reading fluency scores were significantly higher than post-treatment scores for students in first grade. Additionally, these one-year follow-up scores were higher than pretreatment scores across all grades, with an average improvement of 17 percentile rank points in the treatment group.

“The results of this pilot study suggest that the King-Devick remediation software may be effective in significantly improving reading fluency through rigorous practice of eye movements,” says Dr. Starling. “What our study also found was that there was an even greater improvement between first and third grade versus third and fourth graders, which means there may be a critical learning period that will determine reading proficiency.”

“The outcome of this study suggests that early childhood intervention with a simple methodology of eye movement training via the remediation software, which is inexpensive and can be implemented in developed or developing cultures easily, might allow a lasting improvement in ability to read, with clear sociologic ramifications,” says Craig H. Smith, M.D., neuro-ophthalmologist, Chief Medical Officer, Aegis Creative, and Senior Advisor, Bill and Melinda Gates Foundation, and a co-author of the study.

The authors hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.

Commentary:

Training activities by computer undoubtedly bring improvements, at least in regard to eye movements, but vision therapy performed in real space would probably be much more effective.

In addition, the recognition by the medicine (or at least the group of physicians who participated in this study) the effectiveness of vision therapy is a big step for optometry.

Those who dispute the link between vision and academics must critically review and change these misguided beliefs. We cannot afford to let unfounded, dogmatic opinions, professional animosities and political agendas stop our children from achieving single, clear, comfortable and binocular vision while attaining their highest academic level possible.

Yes, there is a link between vision and learning. And yes, vision therapy improves academic performance.

Competent reading essentially involves the whole-word or lexical process of reading which ensures fluent reading and a “direct” access to meaning. It recognizes the shape of the word and immediately find its sound correspondence in memory (or phonological), the meaning of the word being evoked, which is the ultimate goal of reading.

The whole-word process (or eidetic = photographic), both more automatic and faster, can even bypass the phonological pathway, which is more controlled and slower. Most of the time, the expert reader would not need to use his phonological knowledge to recognize written words. The observation of a double dissociation between visual and phonological dyslexia in patients with brain damage is an argument in favor of the neuropsychological existence of the two independent procedures for the recognition of written words (Coltheart, Masterson, Byng, Prior & Riddoch, 1983; Funnell, 1983; Shelton & Weinrich, 1997). Numerous studies supporting these models have also emphasized the optional phonological code while reading (Peereman, 1991, for a review).

When the child becomes able to recognize a word as a unit, he gradually builds his orthographic lexicon. The operation of this lexicon is not yet fully known, but it seems to be like a dictionary which exists in our brain, allowing rapid identification (the faster the more familiar word) and immediate access to meaning.

This procedure then develops to become more and efficient as reading becomes more competent. Ultimately, the adult reader would only use the “photographic” procedure, which is obviously much faster than going through words syllable by syllable (which remains necessary when we must read for example, new or meaningless words or of a foreign language).

In the first case, the child immediately recognizes the words and understands what he reads. In the second case, the child does not read words but syllables one by one. Difficult to quickly understand what is read.

These children do not present associated disorders of oral language and have good capabilities in short term verbal and workong memory and have good phonological awareness. They also have difficulties in visual processing that make comparing sequences of letters or identify targets among others.

It is said that pure forms of surface dyslexia are relatively rare in clinical practice. But I can assure you that in my optometric practice, these children are much more numerous than the statistics show.

Visuo-attentional dyslexia

There is also, according to some authors, another form of dyslexia, called “visual-attentional” where the child has a good memory of the spelling of words and is able to transcribe sounds into words. For cons, the type of errors encountered in this disorder is reversals in groups of letters, omissions, additions, approximate reformulations, skippng lines while they read. line breaks. The child may confuse letters and words with others closely resembling it. It would be a disorder affecting necessary attention for an effcient reading activity.

These children also have oculomotor (eye movement) and visual discrimination problems, difficulties in visual attention, difficulties in copying material from a book or the blackboard.

It is difficult to conceive a child who has a serious visuo-attentional problem would not show a form of surface dyslexia. There is certainly a very close relationship between the two since both can prevent the establishment of a proper orthographic lexicon. They may also be different manifestations of the same problem called “visual dyslexia”. This close relationship between visual and attentional problems is reinforced by the significant progress in reading and spelling seen in a child with surface dyslexia following a trainign program focused on visual processing capabilities (Launay and Valdois , 1999)

It is probably unnecessary to say that the best readers are those who read in a whole-word fashion, this method of reading is fast and understanding is also much better. But what is the action to take if a child uses no or has a poor orthographic lexicon? We must ensure that the related visual and perceptual skills are adequate. Otherwise, visual training will be needed to improve these skills.

What are the skills that have a close relationship with the development of orthographic lexicon? First, eye movements: reading requires a constant movement of the eyes along a line of text, which is done by a series of short jumps (saccades) interspersed with longer breaks during which takes place all intake of visual information. These jumps between fixations are very short, about one-thirtieth of a second. Saccades take approximately 250 to 300ms. Saccades are also an index of visual attention. We have tests that evaluate the speed, accuracy and fluency of reading. Eye movement problems hamper efficient learning and reading quality (failure to follow the text, loss of place, jump words or lines, etc.). For reading to be effective, eye movements must be flexible, fast and accurate.

Then visual attention and concentration allow the child to remain focused and attentive to every detail of what we see and as long as necessary. Attention and concentration are a preqequisite to good visual discrimination. In addition, visual attention is the link between perception (making information available) and cognition (use this information). It ensures maximum reception all the information from our visual environment. Visual concentration promotes maximum use of working memory to collect, store, retrieve and process the relevant information. It facilitates the work and especially the intellectual performance.

Short-term and sequential visual memoriesallow the child to recognize an item after a brief exposure, or to recall items in the same order and in the same sequence. For example, remembering the order of letters in a word or words in a sentence with a quicker understanding of what is read. Children who show difficulties in visual sequential memory may have difficulties copying information from the board or a book, to learn to read mulriple words or sentences and remember what they read. They may also have difficulties in creating their orthographic lexicon, which affects fluency and reading comprehension.

Visualization or mental imagery is the ability to create images of a word, a sentence or a paragraph in our head (our mental picture). This ensures good understanding of what is read and allows a better organization of information, making it easier to retain and build an efficient orthographic lexicon. This perceptual skill is also essential for mental arithmetic and spelling of words. If a child reads a story without being able to mentally see the scene described in the text, then this will influence contextual

In summary, the eyes must move effectively to ensure high quality of visual information, and the child must be able to remain attentive and focused on what he reads. Visual memory will also allow to recognize the same words in a text. Many children can not build a orthographic lexicon because they can not even recognize a word they just read and read again a few lines later. Visualization allows the child to “juggle with words” in his head. And finally, it is practicing reading every day that ensures efficiency in reading. More often we see the same words, the faster they will be included in the orthographic lexicon.

Conclusion

According to scientific research, three basic skills (among others) will thus directly influence reading performance in children: visual memory, visual attention and visualization. The best readers are capable of recognizing whole words easily (eidetic, global or whole-word reading). This accelerates visual decoding, requires less energy and promotes better understanding. Reading phonologically (syllable by syllable) slows down the reading process and does not guarantee an adequate understanding of a text. The best readers need not phonological awareness to read and can recognize most words without having to dissect them. That is why we have developed a particular portion of our vision therapy to enhance these perceptual abilities. We try to develop better whole-word reading to improve reading efficiency and comprehension.

“True“dyslexia is seemingly a “neurological” dysfunction (of course, we read with our brain, not just the eyes!) marked by the inability of the brain centers to efficiently decode print or phonetically make the connection between written symbols and their appropriate sounds. The connotation of the word “neurological” can be confusing: this word is too easily understood or related to a nervous system disease. Dyslexia may be caused by a nervous system dysfonction, but surely not a disease!

The origin of this problem, yet ardently debated in the literature, is probably multi-causal. It is unfortunate that the researchers are constantly looking at only a small aspect of dyslexia in their studies. We also know that not all children who have difficulty reading, however, suffer from phonological processing. Although the symptoms are similar, they may also have visual and perceptual problems that interfere with adequate learning, not just a deficit-based language, as some would have us believe…

Margaret Livingstone, et al, from the Department of Neurobiology, Harvard Medical School and the Dyslexia Research Laboratory, Beth Israel Hospital in Boston reports that poor visual processing plays a significant role in a large majority of children who struggle to read: “Several perceptual studies have suggested that dyslexic subjects process visual information more slowly than normal subjects. Such visual abnormalities were reported to be found in more than 75% of the reading-disabled children tested.”

Moreover, all children with learning difficulties in primary school are not dyslexic, and vice versa, a child may be dyslexic without it being prolonged failure (especially if dyslexia is mild and if it can be compensated by the development of other skills intact).

Essentially, there is also a problem in the clinical definition of dyslexia. Everyone has their own definition and tests used in the diagnosis of such a condition do not always lead to a clear diagnosis… This imprecision in diagnosis can also certainly explain the variability in prevalence rates reported in the literature (this rate may actually increase from 4% (Yule and Rutter, 1973) to 20% (Shaywitz, 1996)).

The phonological process is characterized by a sequential analytical processing or syllabic of a word or pseudo-word (invented word). It involves a system of rules for grapheme (a letter or two, sometimes three) – phoneme (sound related) explicitly learned in school.

The word “camel” when processed through this system will be segmented into graphemes <CA – MEL>, then each grapheme will be assigned to a phoneme which is most frequently associated in the language This allows to generate the sequence of the word.

Only the phonological process allows the processing of new words (words not previously learned or “pseudo-words” which are words invented for the purposes of experiment, for example: famsled, posvent or rolted).

Insofar as the treatment of new words is dedicated to this system, lists of pseudo-words are systematically tested for reading and dictation for children with difficulties, to test the integrity of the phonological process. Good performance in reading invented words indicates that the phonological process is operational, poor performance involves an inadequacy of this pathway.

It is known that the analytical (phonological) route plays a major role in early learning as it is chronologically the first. If we conceive that in adults both channels are relatively autonomous, it seems unlikely that these two pathways are also distinct in children who are learning to read.

Whole-word or eidetic process

The lexical procedure (or whole-word process) performs simultaneous processing of all the elements of the word. All units which compose the word are processed in parallel, leading to the activation of the orthographic lexicon stored in the brain and learned previously. The child sees the word and understands it immediately.

In reading, and after some visual processing, the representation of the word as a whole is activated in our orthographic lexicon (the “dictionary within our head”) and gives a very rapid access to the sound structure (phonology) corresponding to this word and its meaning. No need to decode the word syllable by syllable.

The way this lexicon functions is not yet fully known, but it seems to be like a dictionary to which we would refer for each word read, according to a “photographic” procedure, allowing rapid identification (the faster the more familiar is the word) and immediate access to meaning.

Each of the two procedures for reading (or writing) is implemented specifically for the treatment of certain types of words: the lexical route or process can only deal with words already learned and whose representations are available within the orthographic lexicon and its phonological correspondence. It is needed when reading or writing irregular words that are not pronounced the way they are written (for example, rough, soared, laugh). Irregular words that can only be handled by the lexical route is used in the evaluation of children with learning disabilities. Lists of irregular words are proposed or presented to test the integrity of the lexical route: a good performance when reading these words shows that the lexical procedure is operational; poor performance in reading irregular words compared to reading regular words or pseudo-words suggests a failure of the lexical procedure.

In the previous text, we shared a study on headaches in children and the lack of relevance to either having to wear glasses or changing the lens power of the glasses. One of the issues discussed was the biased scientific methodology and the art of making such statements without seeing further than one’s nose…

Contrary to the statement of the authors and of the American Association of Ophthalmology, there is a source more relevant and of more scientific relevance about headaches and vision of children that is free of any bias examiner. In 2009, a major study both from optometrists and ophthalmologists concerning convergence insufficiency and its symptoms, the CITT study (Convergence Insufficiency Treatment Trial) began. They created a questionnaire called CISS (Convergence Insufficiency Symptom Survey) to link the symptoms to convergence insufficiency. All one has to do to determine if the visual requirements are linked to headaches is to ask! The CISS questionnaire showed that it could be done reliably. You will find the questionnaire at the end of the text. Note the number of items that relate to visual discomfort. You can also download it from: http://www.aoa.org/x13917.xml

Q1: Do your yes feel tired when reading or doing close work?

Q2: Do your eyes feel uncomfortable when reading or doing close work?

Q3: Do you have headaches when reading or doing close work?

Wait a second! Why is it that the best standardized questionnaire in the history of joint studies of optometry and ophthalmology, studies funded by the U.S. government, directly ask a question about headaches associated with visual tasks, while the recent study talked about “proofs beyond doubt” that it is not relevant?

Let’s dispense with the simplistic notions of the latest press release, and set the record straight:

Headaches can be associated with vision problems. Unless you ask the question, you can’t get an answer.

Pediatrician screening is not a substitute for a complete eye exam performed by an optometrist. A child who complains of headache associated with visual tasks near (reading, writing, drawing, etc.) might show a functional problem (alignment problem like convergence and/or focusing), while having no problem with distance visual acuity (vision of 20/20 or 100%).

A change in glasses may sometimes not completely solve the headache. But often wearing new glasses for an individual who was not wearing any will solve the problem.

If the underlying cause of headaches is a functional problem, the treatment of choice according to proved scientific studies is proven optometric vision therapy.

Even in ophthalmology, here is what is said about eyestrain and headaches:

“The visual symptoms are caused by because focusing of the eyes becomes increasingly difficult due to fatigue especially at the end of the day after prolonged reading. Vision becomes blurred and sometimes even double. Vision at near can be uncomfortable.

Eyestrain occurs mainly in the late afternoon as near vision is constantly at work by efforts of focusing in work and in leisure with particularly computer screens, mobile phones, television, console games…

Eye symptoms reflecting visual fatigue include a feeling of discomfort, tension, and heaviness in the region of the eye, orbit or eyelids. There may be feeling of irritation, burning, stinging, and itching, sometimes with red eyes, some tearing or irritation due to dry eye. The subject may feel dull pain but not very intense that may become acute generally behind the eyes.

Headaches can be felt around the eyes, on the forehead above the eyebrow line, temples or behind the head. These headaches are related to eye strain, occur after a certain period of work at the end of the day, fade and disappear after cessation of work.” (Source: http://www.ophtalmologie.fr/fatigue-visuelle-yeux.html)

Does your child wear glasses? If so, has he or she ever complained of headaches that improved or were eliminated with a change of prescription glasses or wearing a pair of glasses for the first time? That would be very rare, at least according to a “study” presented at the meeting of the American Academy of Ophthalmology.

This study from the Albany Medical Center in New York believes that vision problems or eye are rarely the cause of recurrent headaches in children, although headaches usually strike while the child is doing schoolwork or other visual tasks.

The biggest problem: the study was retrospective. Scientists agree that only prospective studies (see below) constitute real scientific evidence. This press release claims clear evidence that vision or eye problems are rarely the cause of headaches, and that there is no correlation between the need for glasses and headaches. And what kind of study is it? A retrospective study!

Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies. For this reason, retrospective investigations are often criticised.

There seems fishy, does it not? Of course! This is another effort by the association of ophthalmologists in the United States to convince the public that glasses are prescribed unnecessarily. The press release highlights the hope that this study will help to reassure parents that most cases of headaches in children are not associated with vision or eye problems, and that most headaches will disappear with time, even if the headaches usually strike while the child is doing schoolwork or other visual tasks. My eye!

A statement of this nature has broad implications, and it intended (?) to assure parents that headaches are not likely to be causes by use of vision. The authors prefer to direct the public to a pediatrician that will decide if a visual examination is necessary rather than consult an optometrist!

The burden of proof for such claims is on the investigators, because it runs counter to gold standard published research. Acknowledged by all parties to be one of the best studies ever published jointly by Optometry and Ophthalmology regarding children’s visual symptoms, the CITT noted that 32% of all children with convergence insufficiency (CI) reported headaches occurring fairly often or always while reading or doing close work. Given that the prevalence of CI occurs to a greater degree in the population studied than strabismus, amblyopia, and high ametropia combined, and that no provision is made in vision screenings by pediatricians or school nurses to detect the condition, this study stands to confuse rather than clarify the role of vision conditions regarding headaches in children.

The authors report that 13.9% (22 children) of their population experienced headaches associated with visual tasks. This means that 86.1% (136 children of a total of 158) of their population had a headache type for which visual input was not a factor, and therefore a severely skewed population in which one would not expect to find that glasses had more than a chance influence.

The authors did not even look at reasons for the disappearance of headaches in children over time. We must understand that headaches are mostly caused by the use of near vision (reading, writing, video games, etc.), often there is an eye alignment problem or a focusing problem. If the problem persists, the visual system will make significant concessions to solve the problem. Most of the time, as an adaptation to visual stress, we will see the child becoming myopic. Headaches do not go away without other visual problems appearing. But the authors did not take this into account…

It is unfortunate that a study so scientifically questionable has made ​​so many headlines everywhere…

Much of learning is associated with visual cues, so children with vision-related problems may find it difficult to keep up with their peers in an academic setting. In order to assess the relationship between success in an academic setting and vision-related problems, we compared the prevalence of vision-related problems between children with Individualized Education Programs (IEPs) to population-based samples from the literature.

An IEP is a written statement that includes a child’s present levels of academic achievement and functional performance, measurable academic and functional goals, alternate assessments aligned to alternate achievement standards (if necessary), and a description of necessary special education services, supplementary aids, and accommodations. An IEP is written by a team of professionals that may include school psychologists, teachers, school nurses, speech and language teachers, and medical specialists in order to set measurable goals and establish a guide for the child’s special learning needs.

Eye care professionals completed a visual examination on children with an IEP. The prevalence of a variety of conditions exhibited by children with IEPs was compared to prevalence rates reported in the literature.

Data were analyzed for 255 children reported to have an IEP. The average age of the children was 9.6 years.

Higher prevalence rates were reported for IEP patients than for samples from the literature for myopia (9 of 13 studies), hyperopia (10 of 13 studies), astigmatism (6 of 9 studies), anisometropia (myopia oy hyperopia different in each eye) (3 of 4 studies), and strabismus (6 of 6 studies). The entering distance visual acuity of IEP patients was 20/40 or worse for 23.7% of them, but 7.2% of eyes still had a visual acuity worse than 20/40 after correcting their problem. Of the children who required some form of treatment, 124 (69.3%) had better than 20/40 entrance visual acuity in both eyes.

Many of these vision problems would solely be undetected by vision screenings based on distance visual acuity, illustrating the need for comprehensive vision examinations for children who are struggling academically.

It has been estimated that 80% of learning is obtained through vision. Although there is no scientific evidence for this statement, few disagree with the assertion. Scientists have found significantly lower achievement test scores, as well as reduced letter and word recognition, receptive vocabulary, emergent orthography, and verbal and performance intelligence quotients among children with uncorrected hyperopia. Furthermore, children with learning disabilities exhibit a greater prevalence of vision-related problems than the entire population. Certain vision problems that may affect learning, but not all, are related to refractive problems (hyperopia, astigmatism and less with myopia), so vision examinations may provide helpful information in the management of children with learning disabilities.

But, what if a child with an IEP also has a vision problem? Wouldn’t that pose a risk to the child responding effectively to their IEP? To attempt to answer this question, 3 states in the US (Illinois, Kentucky and Missouri) have mandatory eye examinations for children before Kindergarten. Only Arkansas, North Carolina, Oklahoma and Massachusetts require examinations for children who fail a school vision screening. And only Ohio and Massachusetts require examinations for children with learning difficulties. Sixteen states do not even require vision screenings for children. Regardless of the state laws, when an eye examination has not been performed by a qualified eye doctor, the school will typically provide a vision screening to determine that vision is functioning “normally”. However, here is where problems begin to surface. Vision screenings are predominantly an eye sight test. That is, if the child’s visual acuity (eye sight) is better than 20/40 they pass the vision screening!

Even more critical to the question of the validity of a school vision screening was another startling conclusion of the team which found that out of the 179 that required treatment, 124 (69%) of the children with IEPs would have passed the school vision screening test.That is to say, nearly 70% of those children with an IEP were identified with treatable vision problems and yet would pass the vision screening because their vision problem did not affect their distant eye sight!

If you are a teacher, insist that any child who has an IEP be seen by an eye doctor who will provide a thorough vision evaluation and provide you with feedback about the results.

If you are a parent, whose child struggles in reading and learning and/or has an IEP, it is imperative that you seek help by a doctor who is thorough, enjoys working with children and either provides office-based vision therapy or will refer you to a qualified doctor who provides office-base optometric vision therapy.

An IEP is a written plan. It is a working document that describes the strengths and needs of an individual exceptional pupil, the special education program and services established to meet that student’s needs, and how the program and services will be delivered. It also describes the student’s progress.

An IEP should be based on a thorough assessment of the student’s strengths, interests, and needs. It should identify specific goals and expectations for the student, and should explain how the special education program will help the student achieve the goals and expectations set out in the plan. The special education program and services the IEP describes should be modified as necessary by the results of continuous assessment and evaluation.

A student’s IEP should be developed, implemented, and monitored in a collaborative manner. The educational growth of a student is best accomplished through the mutual efforts of, and close communication among, the student, the student’s parent, the school, the community, and other professionals involved with the student. The IEP provides an opportunity for all those involved with the student to work together to provide a program that will foster student achievement and success.

In summary, an IEP is…

a summary of the student’s strengths, interests, and needs and of the expectations for a student’s learning during a school year that differ from the expectations defined in the appropriate grade level of the Ontario curriculum;

a written plan of action prepared for a student who requires modifications of the regular school program or accommodations;

a tool to help teachers monitor and communicate the student’s growth;

a plan developed, implemented, and monitored by school staff;

a flexible, working document that can be adjusted as necessary;

an accountability tool for the student, his or her parents, and everyone who has responsibilities under the plan for helping the student meet his or her goals and expectations;